Children in an urban world

The experience of childhood is increasingly urban.
Over half the world’s people – including more than
a billion children – now live in cities and towns.
The UNICEF State of the World’s Children reference
guide presents the most recent key statistics on
child survival, development and protection for the
world’s countries, territories and regions in a single
volume on an annual basis. The 2012 edition has
sought to shed light on the experience of children
and young people in urban areas, especially the
poorest and most marginalised. This report focuses
mainly on those children in urban settings all over
the world who face a particularly complex set of
challenges to their development and the fulfilment
of their rights.

In 2011, for the first time, The State of the
World’s Children 2011 included tables on Adolescents
and Equity, the latter focusing on disparities by
household wealth. The State of the World’s Children
2012 adds a second table on Equity,
focusing on urban-rural disparities.
This new table (Table 12 of the
report) provides urban, rural and
urban:rural ratio data for the following
indicators – birth registration,
skilled attendant at birth, underweight
prevalence in children under
5 years, under-fives with diarrhoea
receiving oral rehydration solution
(ORS) and continued feeding,
primary school net attendance ratio,
comprehensive knowledge of HIV
(females 15-24y), and % population
using improved sanitation facilities.
Table 6 of the report includes %
population urbanised and average
annual growth rate of the urban
population.

The report highlights a key challenge to assessing
children’s wellbeing in urban settings is the lack
of disaggregated data. In rural v urban comparisons,
urban results tend to be better, whether in
terms of the proportion of children reaching their
first or fifth birthday, going to school or gaining
access to improved sanitation. But these comparisons
rest on aggregate figures in which the
hardships endured by poorer urban children are
obscured by the wealth of communities elsewhere
in the city. Where detailed urban data are available,
they reveal wide disparities in children’s rates of
survival, nutritional status and education resulting
from unequal access to services. Gathering accessible,
accurate and disaggregated data is an essential
step in the process of recognising and improving
the situation of children in urban areas.

The report considers in particular the rights of
children to shelter, health, nutrition, water, sanitation
and hygiene, education and protection. Issues
raised include:

Inadequate living conditions are among the
most pervasive violations of children’s rights. The
lack of decent and secure housing and such infrastructure
as water and sanitation systems makes it
so much more difficult for children to survive and
thrive. Yet, the attention devoted to improving
living conditions has not matched the scope and
severity of the problem. Evidence suggests that more
children want for shelter and sanitation than are deprived of food, education and health care, and
that the poor sanitation, lack of ventilation, overcrowding
and inadequate natural light common in
the homes of the urban poor are responsible for
chronic ailments among their children.

The locus of poverty and undernutrition among
children appears to be gradually shifting from rural
to urban areas, as the number of the poor and
undernourished increases more quickly in urban
than in rural areas. However, even the apparently
well fed – those who receive sufficient calories to
fuel their daily activities – can suffer the ‘hidden
hunger’ of micronutrient malnutrition: deficiencies
of such essentials as vitamin A, iron or zinc from
fruits, vegetables, fish or meat. In a number of
countries, stunting is equally prevalent, or more so,
among the poorest children in urban areas as
among comparably disadvantaged children in the
countryside.

Nearly 8 million children died in 2010 before
reaching the age of 5, largely due to pneumonia,
diarrhoea and birth complications. Some studies
show that children living in informal urban settlements
are particularly vulnerable. High urban child
mortality rates tend to be seen in places where
significant concentrations of extreme poverty
combine with inadequate services, as in slums. For
example, around two thirds of the population of
Nairobi, Kenya, lives in crowded informal settlements,
with an alarming under-five mortality rate
of 151 per thousand live births. Pneumonia and
diarrhoeal disease are among the leading causes of
death. Poor water supply and sanitation, the use of
hazardous cooking fuels in badly ventilated spaces,
overcrowding and the need to pay for health services
– which effectively puts them out of reach for
the poor – are among the major underlying causes
of these under-five deaths.

Urban settings provide proximity to maternity
and obstetric emergency services but, yet again,
access and use are lower in poorer quarters – not
least because health facilities and skilled birth
attendants are in shorter supply. The report
includes a case study of good practice around
maternal and child health services for the urban
poor from Nairobi, Kenya.

There is some evidence that urban mothers are
less likely than rural ones to breastfeed and more
likely to wean their children early if they do begin. An analysis of Demographic and Health Survey
(DHS) data from 35 countries found that the
percentage of children who were breastfed was
lower in urban areas. Low rates of breastfeeding
may be attributed in part to a lack of knowledge
about the importance of the practice and to the
reality that poor women in urban settings who
work outside the home are often unable to breastfeed.

Around 2.5 million under-five deaths are
averted annually by immunisation against diphtheria,
pertussis and tetanus (DPT) and measles.
Global vaccination coverage is improving but more
needs to be done. Lower levels of immunisation
contribute to more frequent outbreaks of vaccinepreventable
diseases in urban communities that are
already vulnerable owing to high population
density and a continuous influx of new infectious
agents. Poor service delivery, parents who have low
levels of education, and lack of information about
immunisation are major reasons for low coverage
among children in slums as diverse as those of
western Uttar Pradesh, India, and Nairobi, Kenya.

Urban life can also have a negative effect on the
mental health of children and adolescents, particularly
if they live in poor areas and are
exposed to the dangers of violence
and substance abuse. Disrupted and
poor access to education by children,
protection issues (risk of trafficking,
child labour, and living and working
on the streets) add to risks. Migrant
children are often on the periphery of
service access and 1 in 5 moves to an
urban settlement without a parent.

When emergencies occur in
marginalised urban areas, children
are among the most susceptible to
injury and death. Over three quarters
of casualties in recent decades have
been children in sub-Saharan Africa
or South Asia. Droughts, flooding
and post-disaster conditions all intensify
pre-existing risks. Information on
slum communities is often inadequate, outdated or
non-existent, making it difficult to locate the most
vulnerable and those in greatest need. There are
examples of successful practices in community
identification from Nairobi and the Philippines.

In poor urban areas, failures in development
contribute to disasters, and disasters, in turn, undo
or undermine development gains – deepening
poverty and further widening the social and health
gaps separating poor from rich. Routine, smallscale
calamities in many settlements result from
poor governance, planning and management, and
often indicate vulnerability to much larger disasters.
Existing poor health and nutrition can
increase disaster risk for children, hamper recovery
and, if not addressed in the emergency response,
leave children more vulnerable to future shocks.
When disaster strikes, supportive environments
critical to children’s well-being may break down.
Families may remain in emergency camps for
extended periods, and these dysfunctional environments
can become the only home children know
during their formative years.